Interferon Treatment for Patients With Chronic Hepatitis C Complicated With Chronic Renal Failure Receiving Hemodialysis

Akira Kojima; Satoru Kakizaki; Ken-ichi Hosonuma; Yuichi Yamazaki; Norio Horiguchi; Ken Sato; Tokuyuki Kitahara; Masatomo Mori

Disclosures

J Gastroenterol Hepatol. 2013;28(4):690-699. 

In This Article

Abstract and Introduction

Abstract

Background and Aims: The Japan Society for Dialysis Therapy established "Guidelines for the Treatment of Hepatitis C Virus Infection in Dialysis Patients." We evaluated the status of HCV infection and the treatment of hemodialysis patients in Gunma prefecture.

Methods: Questionnaires concerning the infection rate, recognition of the guidelines, and treatment status were sent to all 64 hospitals/clinics that had hemodialysis systems in Gunma prefecture. The hepatitis C virus-infected hemodialysis patients who received pegylated interferon (peg-IFN) were analyzed at Gunma University Hospital.

Results: The positive rate for hepatitis C virus antibody was 256/2582 hemodialysis patients (9.9%). The positive rate varied between institutions (range 0–40.0%; median 9.0%). All institutes recognized the establishment of the guidelines. Conventional or peg-IFN treatment was being given at 37.5% of the institutions. The other 62.5% institutions answered that they intended to provide the treatment in the future if collaboration with a hepatologist could be arranged. The most common answers regarding the indication for IFN treatment were as follows: few complications, under 60 years of age, more than 10 years of survival expected on hemodialysis. Eighteen patients received peg-IFN treatment. The sustained virological response rate of all patients was 33.3%, 0% in 1b/high viral titer, 50% in genotype 2, and 100% in genotype 2/low viral titer. The sustained virological response rate was worse in the patients with 1b/high viral load and diabetic nephropathy (P < 0.05).

Conclusions: Recognition of the publication of the guidelines was high. However, the number of patients treated with peg-IFN was still low. Further enlightenment and cooperation between hemodialysis teams and hepatologists are therefore needed.

Introduction

The positive rate for hepatitis C virus (HCV) infection is higher in patients with chronic renal failure receiving hemodialysis (HD) than in the general population.[1] Despite the introduction of blood-product screening, the increased use of erythropoietin, as well as the adoption of universal precautions and strict infection controls, HCV infection still remains a major health problem in patients with HD.[1] The reported prevalence rates of chronic HCV infection among HD patients ranges from 3.4% to 80%, with geographic variation.[1–8]

Because the morbidity and mortality rates in HD patients are generally higher than those in the general population, the long-term consequences of HCV infection in these patients had been difficult to clarify.[1] However, recent studies have clearly shown that HCV-infected HD patients are at an increased risk of liver-related mortality.[9–12] In addition, HCV infection adversely decreases the health-related quality of life in these patients.[13] Furthermore, HCV infection accelerated hepatic fibrosis and the deterioration of hepatic necroinflammation after renal transplantation, thus suggesting that immunosuppression following renal transplantation could worsen the course of liver damage.[14,15]

In patients with a normal kidney function, treatment with pegylated interferon (peg-IFN) and ribavirin can lead to eradication of HCV.[16–20] However, such treatment is problematic in patients with an impaired kidney function in part because of the altered pharmacokinetics of these medications. Ribavirin is considered to be contraindicated for the treatment of HD patients with chronic hepatitis C because of the risk of life-threatening hemolytic anemia. However, several studies have shown that using low-dose ribavirin in combination with conventional IFN was feasible for HD patients with chronic hepatitis C.[21,22] As a result, the optimal strategy in this group of patients is not well defined. The Japan Society for Dialysis Therapy (JSDT) recently established "Guidelines for the Treatment of Hepatitis C Virus Infection in Dialysis Patients" in June 2011.[23] In these guidelines, three therapeutic regimens were recommended, including peg-IFN-alpha-2a 90–135 μg/once a week for 24–48 weeks, natural-IFN-alpha or IFN-alpha-2b 300~600 MIU/three times a week for 24–48 weeks, and natural IFN-beta 300~600 MIU/three times a week for 24–48 weeks.[23,24]

In this study, we evaluated the status of HCV infection and the treatment of HD patients in Gunma prefecture. The infection rate, recognition of the guidelines, and treatment status were investigated. For the treatment for HCV-infected HD patients, the collaboration between HD teams and hepatologist may be needed. We also describe our strategy for developing a therapeutic network for HCV-infected HD patients based on the collaboration between HD teams and hepatologists.

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